{"id":3319,"date":"2010-09-21T16:32:47","date_gmt":"2010-09-21T20:32:47","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?p=3319"},"modified":"2011-07-19T17:45:27","modified_gmt":"2011-07-19T21:45:27","slug":"see-everything-2","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2010\/09\/21\/see-everything-2\/","title":{"rendered":"See Everything"},"content":{"rendered":"

John Mandrola is a cardiac electrophysiologist and blogger on matters medical and general. Here is a recent post from his blog <\/em>Dr John M<\/em><\/a>.<\/em><\/p>\n

Do you see anything wrong with this picture?<\/p>\n

\"\"<\/a><\/p>\n

(Hint: see the right column)<\/p>\n

I guess the European electrophysiologists couldn’t wait for us in North America. \u00a0They have published their own 54,000 word Euro-specific guidance on AF management<\/a>. It is certainly true that atrial fibrillation management guidelines needed an update; the last comprehensive\u00a0revision was in 2006. \u00a0Much has changed in AF therapy, including the expanded role of catheter ablation and the soon-to-be warfarin substitutes.\u00a0There are some neat new topics in this revision: a novel symptom score for AF, refinement of the CHADS2 scale for predicting stroke risk (in anticipation of new anticoagulants), and an expanded role of catheter ablation. All of these are welcome, fairly uncontroversial additions.\u00a0The more contentious issue is the role of “newer anti-arrhythmic agents.”<\/p>\n

Well, that could only mean one thing . . . yes, you guessed\u00a0 . . . dronedarone.<\/p>\n

From Dr J Camm (a prominent British professor and a paid consultant for Sanofi), as quoted in a Heartwire\u00a0article<\/a>, we hear:<\/p>\n

For rhythm control, the guidelines incorporate the new antiarrhythmic drug dronedarone, which was approved by the European Medicines Agency at the end of last year, into the recommendations. “We’re saying, from a benefit\/risk point of view, that dronedarone is widely applicable.”<\/em><\/p><\/blockquote>\n

“Widely applicable,” he says? Of dronedarone? \u00a0Hmm.<\/p>\n

There are ample dronedarone data in the literature. As treatment forAF, it is touted for its safety and its reduction of hospitalizations. \u00a0But not all the\u00a0findings are\u00a0so flattering. \u00a0Especially, these less-than-striking\u00a0data<\/a> on its efficacy for suppressing AF. The selective emphasis in the reporting of dronedarone trials is chronicled\u00a0here<\/a>, on Cardiobrief.<\/p>\n

The catch with dronedarone is that patients with symptomatic AF look to us to help relieve their symptoms. Favorable statistics are one thing — dronedarone researchers have plenty of data to publish articles. However,\u00a0in the real world, where AF patients consider their treatment successful when their AF stops, lack of AF-suppression is a challenging hurdle to overcome. But they will try, with paid professors and banner ads on\u00a0purportedly information-only websites.<\/p>\n

Dronedarone’s lack of efficacy will sort itself out\u00a0in time. It will find its limited role. But until then, the banner ads and proclamations from the universities will likely continue.<\/p>\n

I was taught in medical school to look around on entering a patient’s room, to take in everything — the sights and smells, the family, the monitors, and even the patient’s reading material. \u00a0Much can be learned from the background, the sidelines. \u00a0This is also good advice\u00a0when reading information on the internet. \u00a0Take in everything, including\u00a0a look at what’s on the right of the page to see who is paying to promulgate the information.<\/p>\n

Eyes open.<\/p>\n","protected":false},"excerpt":{"rendered":"

John Mandrola is a cardiac electrophysiologist and blogger on matters medical and general. Here is a recent post from his blog Dr John M. Do you see anything wrong with this picture? (Hint: see the right column) I guess the European electrophysiologists couldn’t wait for us in North America. \u00a0They have published their own 54,000 […]<\/p>\n","protected":false},"author":655,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[13],"tags":[341,410,409],"class_list":["post-3319","post","type-post","status-publish","format-standard","hentry","category-electrophysiology","tag-atrial-fibrillation","tag-dronedarone","tag-multaq"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/3319","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/655"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=3319"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/3319\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=3319"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=3319"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=3319"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}